Five thousand years of minimal access surgery: 1990-present: organisational issues and the rise of the robots

Abstract

The last 30 years have seen a revolution in the provision of minimal access surgery for many conditions, and technological advances are increasing exponentially. Many instruments are superseded by improved versions before the NHS and publicly funded health services can offer widespread coverage. Although we tend to think of minimal access surgery as a modern concept, Parts I and II of this series have shown that there is a 5000-year history to this specialty and our predecessors laid down many principles which still apply today. During the 19th and early 20th centuries, minimal access surgery was driven forward by visionary individuals, often in the face of opposition from colleagues and the medical establishment. However, in the last 30 years, innovation has been driven more in partnerships between healthcare, scientific, financial, educational and charitable organisations. There are far too many individuals involved to detail every contribution here, but this third part of the series will concentrate on some of the important themes in the development of minimal access surgery to its current status.

Keywords: History of medicine; general surgery; surgery.

Figure 1.

Da Vinci robot drawing blood from James Bond in the film Die Another Day (2002).¹⁹ For Video see www.youtube.com/watch?v=oXn7TyI1VEk.

Figure 2.

Illustration of robotic grasper with multiple degrees of freedom of movement mimicking human wrist mobility.

Figure 3.

Trends in proportion of laparoscopic colorectal cancer resections in the UK – taken from National Bowel Cancer Audit Project reports 2010–2019.

Figure 4.

Single-incision laparoscopic surgery port and instruments.